Nontraumatic atlanto-axial subluxation after retropharyngeal cellulitis: Grisel's syndrome

Grisel’s syndrome, or nontraumatic atlantoaxial subluxation, is a rare complication of inflammatory processes in the head and neck. Children are most frequently affected and classically present with torticollis after an infectious process or otolaryngologic surgery. Distention and abnormal laxity of the ligaments surrounding the atlanto-axial articulation results from direct spread of inflammation from the pharynx and nasopharynx and can result in cervical spine instability with devastating neurologic sequelae. We describe a case of retropharyngeal cellulitis in a 7-yearold boy progressing to atlanto-axial subluxation with osteomyelitis of the dens. The pathogenesis, diagnosis, and treatment of Grisel’s syndrome are discussed.